Management of the Index COVID -19 Obstetric Patient at the University of Benin Teaching Hospital

Introduction: The novel coronavirus (COVID-19) was first identified in Wuhan City, Hubei province of China, November 2019. As at September 2020, over 28 million infections have been identified with almost a million deaths worldwide causing an alarming pandemic. Clinical presentations in pregnant patients with COVID-19 could be atypical with normal temperature (56%) and leukocytosis. This is further masked by the features of pregnancy.

We present the management of a COVID-19 parturient in our obstetric unit.

Case Report: A 32 year old unbooked G₃P₁⁺1 lady at 32 weeks who presented via referral from a private facility with a history of elevated blood pressure and ++ of protein in urine. Also, complaints of cough and difficulty with breathing. On examination she was noted to be anxious, afebrile, not pale, anicteric, acyanosed, not dehydrated. Had bilateral pedal oedema. Tachypnic with a respiratory rate of 28 cycles per min with basal crepitations. Pulse rate was 96bpm full and regular. Blood pressure was 180/100 mmHg. Heart sounds S₁S₂only.An impression of Chronic hypertension with superimposed pre-eclampsia at 32 wks GA in a primipara with one previous CS with pulmonary edema. Keep in view COVID-19.

She was managed with oxygen, antihypertensives, steroids, while observing strict infection control protocol. She had an emergency caesarean section under subarachnoid block and was delivered of a live female neonate. A confirmatory positive result for covid-19 was obtained 24hrs later. Neonate was however negative. None of the staff became positive also.

Conclusion: The management of suspected cases of COVID-19 infection should be same as cases already confirmed. As the epidemic persists, numbers will continue to rise andhence our index of suspicion should be heightened. Pregnant women will also present with symptoms masked by the features of a sick parturient. Full complement of PPE must be worn by all staff attending to both confirmed and suspicious cases of COVID-19 infection and strict adherence to stated protocols must be observed.